Healthcare Provider Details

I. General information

NPI: 1669851085
Provider Name (Legal Business Name): UMANSKY MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 REGENTS PARK ROW SIUTE #260
LA JOLLA CA
92037-9124
US

IV. Provider business mailing address

4150 REGENTS PARK ROW SIUTE #260
LA JOLLA CA
92037-9124
US

V. Phone/Fax

Practice location:
  • Phone: 858-550-9697
  • Fax: 858-550-9698
Mailing address:
  • Phone: 858-550-9697
  • Fax: 858-550-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM S. UMANSKY
Title or Position: OWNER
Credential: MD
Phone: 858-550-9697